1
|
Cardoso A, Mira C, Ataíde M, Protásio J, Vide J, Resende Sousa M, Mendes D. Influence of tendon injuries on the clinical outcome of ankle and hindfoot fractures. Foot Ankle Surg 2022; 28:319-323. [PMID: 33879387 DOI: 10.1016/j.fas.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Associations of tendon injuries with ankle and hindfoot fractures is a current concern and recent research has linked specific fractures with specific tendon injuries, despite its functional impact being unknown. The purpose of this study is to assess that impact. METHODS Computed tomography scans of patients with ankle and hindfoot fractures were reviewed for tendon injuries. Patients were clinically evaluated with the Visual Analogue Scale (VAS) and the Manchester-Oxford Foot Questionnaire (MOXFQ), via a telephonic interview. RESULTS Eighty-five patients were included in the study. The mean age was of 49.9 ± 16.5 (14-80) years and there were 43 females (50,6%). Mean follow-up was of 43,7 ± 15,1 (24,4-82,2) months. Tendon injuries were identified in 23 patients (27,1%) and the most common lesion was tendon entrapment. The tibialis posterior tendon (TP) was injured in 18 patients (21,2%) and comprised 58,1% of all tendon injuries. Tendon injuries were mostly associated with pilon fractures, which was the most common fracture type (44,7%). There was no clinical difference between patients with a tendon injury [VAS of 4,3 ± 2,6 (0-8) and MOXFQ score of 35,1 ± 22,4 (5-80)], and those without [VAS of 3,9 ± 2,5 (0-10) and MOXFQ of 34,3 ± 26,0 (0-95), respectively (p = 0,281 and 0,689)]. CONCLUSION Tendon injuries were present in 27% of patients with ankle and hindfoot injuries. The most frequently injured tendon was the TP in association with pilon fractures, with entrapment being the most common lesion. These lesions, however, do not seem to reflect in a worse functional outcome at two years of follow-up.
Collapse
|
2
|
Lockard CA, Chang A, Clanton TO, Ho CP. T2* mapping and subregion analysis of the tibialis posterior tendon using 3 Tesla magnetic resonance imaging. Br J Radiol 2019; 92:20190221. [PMID: 31596118 DOI: 10.1259/bjr.20190221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Early detection of tibialis posterior tendon changes and appropriate intervention is necessary to prevent disease progression to flat-foot deformity and foot/ankle dysfunction, and the need for operative treatment. Currently, differentiating between early-stage tibialis posterior tendon deficiency patients who will benefit from conservative vs more aggressive treatment is challenging. The objective of this work was to establish a quantitative MRI T2* mapping method and subregion baseline values in the tibialis posterior tendon in asymptomatic ankles for future clinical application in detecting tendon degeneration. METHODS 26 asymptomatic volunteers underwent T2* mapping. The tendon was divided axially into seven subregions. Summary statistics for T2* within each subregion were calculated and compared using Tukey post-hoc pairwise comparisons. RESULTS Results are reported for 24 subjects. The mean tibialis posterior tendon T2* was 7 ± 1 ms. Subregion values ranged from 6 ± 1 to 9 ± 2 ms with significant between-region differences in T2*. Inter- and intrarater absolute agreement intraclass correlation coefficient (ICC) values were all "excellent" (0.75 < ICC=1.00) except for regions 5 through 7, which had "fair to good" interrater and/or and intrarater ICC values (0.4 < ICC=0.75). CONCLUSION A tibialis posterior tendon T2* mapping protocol, subregion division method, and baseline T2* values for clinically relevant regions were established. Significant differences in T2* were observed along the tendon length. ADVANCES IN KNOWLEDGE This work demonstrates that regional variation exists and should be considered for future T2*-based research on posterior tibias tendon degeneration and when using T2* mapping to evaluate for potential tibialis posterior tendon degeneration.
Collapse
Affiliation(s)
- Carly Anne Lockard
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000 Vail, Colorado 81657, United States
| | - Angela Chang
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000 Vail, Colorado 81657, United States
| | - Thomas O Clanton
- The Steadman Clinic, 181 West Meadow Drive, Suite 400 Vail, Colorado 81657, United States
| | - Charles P Ho
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000 Vail, Colorado 81657, United States
| |
Collapse
|
3
|
Incidence and Association of CT Findings of Ankle Tendon Injuries in Patients Presenting With Ankle and Hindfoot Fractures. AJR Am J Roentgenol 2017; 208:373-379. [DOI: 10.2214/ajr.16.16657] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
4
|
Ribbans WJ, Garde A. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete. Foot Ankle Clin 2013; 18:255-91. [PMID: 23707177 DOI: 10.1016/j.fcl.2013.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes.
Collapse
Affiliation(s)
- William John Ribbans
- The University of Northampton, School of Health, Park Campus, Northampton NN2 7AL, UK.
| | | |
Collapse
|
5
|
Lee K, Byun WJ, Ha JK, Lee WC. Dislocation of the tibialis posterior tendon treated with autogenous bone block: a case report. Foot Ankle Int 2010; 31:254-7. [PMID: 20230706 DOI: 10.3113/fai.2010.0254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: V, Expert Opinion
Collapse
Affiliation(s)
- Kang Lee
- Inje University Seoul Paik Hospital, Department of Orthopaedic Surgery, Seoul, Republic of Korea
| | | | | | | |
Collapse
|
6
|
Boss AP, Hintermann B. Tibialis posterior tendon dislocation in combination with achilles tendon rupture: a case report. Foot Ankle Int 2008; 29:633-6. [PMID: 18549765 DOI: 10.3113/fai.2008.0633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Andreas P Boss
- SRO AG, Orthopaedics and Traumatology, St Urbanstrasse 67, Langenthal, BE 4900, Switzerland.
| | | |
Collapse
|
7
|
Takao M, Uchio Y, Naito K, Fukazawa I, Ochi M. Arthroscopic assessment for intra-articular disorders in residual ankle disability after sprain. Am J Sports Med 2005; 33:686-92. [PMID: 15722274 DOI: 10.1177/0363546504270566] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After ankle sprain, there can be many causes of disability, the origins of which cannot be determined using standard diagnostic tools. HYPOTHESIS Ankle arthroscopy is a useful tool in identifying intra-articular disorders of the talocrural joint in cases of residual ankle disability after sprain. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS The authors gathered the independent diagnostic results of physical examination, standard mortise and lateral radiography, stress radiography of the talocrural joint, and magnetic resonance imaging for 72 patients with residual ankle disability lasting more than 2 months after injury (mean, 7 months after injury). They performed arthroscopic procedures and compared the double-blind results. RESULTS In all cases, the arthroscopic results matched those of other means of diagnosis. In 14 cases, the arthroscopic approach exceeded the capabilities of the other methods. Including duplications, 39 patients (54.2%) had anterior talofibular ligament injuries, 17 patients (23.6%) had distal tibiofibular ligament injuries, 29 patients (40.3%) had osteochondral lesions, 13 patients (18%) had symptomatic os subfibulare, 3 patients (4.2%) had anterior impingement exostosis, and 3 patients (4.2%) had impingement due to abnormally fibrous bands. There were only 2 cases in which the cause of symptoms could not be detected by ankle arthroscopy, compared with 16 cases in which the cause of disability could not be detected using standard methods. In 3 cases (17.6%) of distal tibiofibular ligament injuries, 8 cases (27.6%) of osteochondral lesions, and all 3 cases (100%) of impingement of an abnormal fibrous band, ankle arthroscopy was the only method capable of diagnosing the cause of residual ankle pain after a sprain. CONCLUSION The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study.
Collapse
Affiliation(s)
- Masato Takao
- Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1 Enya, Izumo, Shimane 693-8501, Japan.
| | | | | | | | | |
Collapse
|
8
|
|
9
|
Perry MB, Premkumar A, Venzon DJ, Shawker TH, Gerber LH. Ultrasound, magnetic resonance imaging, and posterior tibialis dysfunction. Clin Orthop Relat Res 2003:225-31. [PMID: 12616063 DOI: 10.1097/00003086-200303000-00029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors studied posterior tibialis tendons in 31 subjects with posterior tibialis tendon pain to compare clinical findings with those of magnetic resonance imaging and ultrasound images. All subjects received clinical, ultrasound, and magnetic resonance imaging examinations using T1-weighted, T2-weighted, and enhanced magnetic resonance imaging, and high resolution ultrasound using power Doppler. Forty-four tendons in 25 women and six men with a mean age 43.3 years (range, 20-73 years) were studied. Magnetic resonance imaging tendon and peritendon enhancement are associated statistically with increasing pain intensity on resistance to testing. Ultrasound tendon and peritendon flow were associated with increasing pain intensity on resistance to testing. There is no statistically significant association between magnetic resonance imaging inhomogeneity and pain intensity on resistance to testing. Clinical and ultrasound examinations positively identify peritendinitis and tendonitis but not inhomogeneity (partial tear) of the posterior tibialis tendon. The magnetic resonance imaging is a more sensitive test for posterior tibialis tendon tear than either clinical or ultrasound evaluation.
Collapse
Affiliation(s)
- Monique B Perry
- Rehabilitation Medicine Department, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1604, USA.
| | | | | | | | | |
Collapse
|
10
|
Imhauser CW, Abidi NA, Frankel DZ, Gavin K, Siegler S. Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity. Foot Ankle Int 2002; 23:727-37. [PMID: 12199387 DOI: 10.1177/107110070202300809] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study quantified and compared the efficacy of in-shoe orthoses and ankle braces in stabilizing the hindfoot and medial longitudinal arch in a cadaveric model of acquired flexible flatfoot deformity. This was addressed by combining measurement of hindfoot and arch kinematics with plantar pressure distribution, produced in response to axial loads simulating quiet standing. Experiments were conducted on six fresh-frozen cadaveric lower limbs. Three conditions were tested: intact-unbraced; flatfoot-unbraced; and flatfoot-braced. Flatfoot deformity was created by sectioning the main support structures of the medial longitudinal arch. Six different braces were tested including two in-shoe orthoses, three ankle braces and one molded ankle-foot orthosis. Our model of flexible flatfoot deformity caused the calcaneus to evert, the talus to plantarflex and the height of the talus and medial cuneiform to decrease. Flexible flatfoot deformity caused a pattern of medial shift in plantar pressure distribution, but minimal change in the location of the center of pressure. Furthermore, in-shoe orthoses stabilized both the hindfoot and the medial longitudinal arch, while ankle braces did not. Semi-rigid foot and ankle orthoses acted to stabilize the medial longitudinal arch. Based on these results, it was concluded that treatment of flatfoot deformity should at least include use of in-shoe orthoses to partially restore the arch and stabilize the hindfoot.
Collapse
Affiliation(s)
- Carl W Imhauser
- Drexel University, Department of Mechanical Engineering and Mechanics, Philadelphia, PA 19104, USA
| | | | | | | | | |
Collapse
|
11
|
Bencardino JT, Rosenberg ZS, Serrano LF. MR IMAGING OF TENDON ABNORMALITIES OF THE FOOT AND ANKLE. Magn Reson Imaging Clin N Am 2001. [DOI: 10.1016/s1064-9689(21)00533-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Cheung Y, Rosenberg ZS. MR IMAGING OF LIGAMENTOUS ABNORMALITIES OF THE ANKLE AND FOOT. Magn Reson Imaging Clin N Am 2001. [DOI: 10.1016/s1064-9689(21)00535-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
13
|
Abstract
Sonography of the foot and ankle offers many advantages. Currently, sonographic evaluation rivals or exceeds MR imaging for evaluation of tendons, joint and bursal pathology, and specific soft tissue pathology. The advantages of sonographic evaluation provide a strong impetus for applying this modality to imaging of foot and ankle pathology. Those who accept the challenge will have an expanded repertoire to offer in the pursuit of efficient and effective patient care.
Collapse
Affiliation(s)
- D P Fessell
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, USA
| | | |
Collapse
|
14
|
Ellen MI, Young JL, Sarni JL. Musculoskeletal rehabilitation and sports medicine. 3. Knee and lower extremity injuries. Arch Phys Med Rehabil 1999; 80:S59-67. [PMID: 10326904 DOI: 10.1016/s0003-9993(99)90104-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of knee and lower extremity injuries that commonly occur during athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.
Collapse
Affiliation(s)
- M I Ellen
- University of Pennsylvania Medical Center, Philadelphia 19104, USA
| | | | | |
Collapse
|
15
|
Abstract
Lateral ankle sprains are the most frequently encountered injuries in sports. In the evaluation of lateral ankle injury, one should consider all soft tissue structures (i.e., peroneal tendons, ligaments of the ankle, subtalar joints, around the lateral ankle). The treatment of most ankle sprains has evolved from immobilization to functional rehabilitation. Many patients with ankle sprains return to their previous activities. A few patients are left with pain and residual instability after conservative treatment; thus, the question of when to operate on acute severe ankle sprain remains controversial. The other challenge physicians face is the problem of persistent lateral ankle pain after sprain. This condition may be due to intra-articular or extra-articular pathology (i.e., soft tissue lateral ankle impingement, osteochondral lesion, or partial peroneal tendon tear). Diagnosis can be made with careful history, physical examination, and appropriate ancillary studies. Only proper diagnosis can lead to uncompromised, undelayed patient care.
Collapse
Affiliation(s)
- S H Liu
- UCLA Medical Center 90095, USA
| | | |
Collapse
|
16
|
Bencardino J, Rosenberg ZS, Delfaut E. MR IMAGING IN SPORTS INJURIES OF THE FOOT AND ANKLE. Magn Reson Imaging Clin N Am 1999. [DOI: 10.1016/s1064-9689(21)00504-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Marks RM, Schon LC. Posttraumatic posterior tibialis tendon insertional elongation with functional incompetency: a case report. Foot Ankle Int 1998; 19:180-3. [PMID: 9542993 DOI: 10.1177/107110079801900314] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We present a case report and literature review of distal intrasubstance rupture of the posterior tibial tendon with progressive pes planovalgus secondary to tendon incompetence. Three months after a severe ankle sprain, a 25-year-old basketball player presented with ankle weakness and pain. Treatment by advancement of the posterior tibial tendon to the navicular and medial displacement osteotomy of the calcaneal tuberosity restored alignment, strength, and full function.
Collapse
Affiliation(s)
- R M Marks
- Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA
| | | |
Collapse
|